Apicoectomy

What is an apicoectomy?

This diagram should help clarify this simple procedure. A local anesthetic will be administered around the area of the tooth. The doctor makes an incision in the gum tissue to expose the bone and surrounding infected tissue. The damaged tissue is removed along with the root end tip. A root-end filling is placed to prevent reinfection of the root and surrounding tissue and bone, and the gum is sutured. The bone naturally heals around the root over a period of months restoring normal function.

This procedure is performed under the visualization of the surgical operating microscope. Thus we tend to call apico surgery “Micro-surgery.” The enhanced magnification and illumination allow us to perform this procedure with the utmost precision and thoroughness not capable with the naked eye or even loupes.

Following the surgical procedure, there may be some discomfort or slight swelling while the incision heals. This is not abnormal for any surgical procedure. Most patients return to work or normal daily activities within a short period of time.

Why would I need endodontic surgery?

In the majority of cases a root canal or retreatment is all that is needed to save your tooth from extraction. Occasionally, these non-surgical procedures may not be sufficient to heal your tooth and your endodontist may recommend surgery. Endodontic surgery can be used to locate fractures or accessory canals that don’t appear on the x-ray but still manifest pain and infection. Often the end of the root has embedded bacteria in the root structure or branching of the canal(s) where it was untreatable. Damaged root surfaces or persistent infection in the bone area after a root canal treatment may also be treated with this procedure.

Sometimes endodontic surgery is needed if it is too complicated to complete endodontic treatment or retreatment. Broken files left behind in the canal, large posts placed inside the root, difficult and complex anatomical curvatures and variations of the root, and persistent cysts are just a few of the reasons endodontic surgery may be a better option. Your endodontist will be able to explain this further.

Intentional replantation involves careful extraction of the affected tooth and repairing the tooth endodontically outside the mouth. The tooth is then reinserted or replanted into the socket. This procedure is performed in situations when apico surgery is not possible.